Is retinitis pigmentosa absolutely incurable?

The importance of phosphatides in the biochemistry of the retina and in visual function provided a basis for therapeutic administration of these substances in cases of senile maculopathy and retinitis pigmentosa. In cases of dry senile maculopathy, good results were only obtained by administering (n-3)-docosahexaenacid to the retina as the active component of intramuscular injections of Etaretin. So far only one report of a convincing therapeutic success in a case of retinitis pigmentosa has been published.     

高度近视黄斑病变分类及眼底血管造影特征分析

目的探讨高度近视黄斑病变的类型及荧光素眼底血管造影（fundus fluorescein angiography，FFA）特征。方法对诊断为高度近视黄斑病变的88例（125眼）患者行眼底彩色照相及FFA，分析其图像特征。结果高度近视黄斑病变根据其FFA表现可分为6种类型：（1）漆样裂纹性黄斑病变：25例36眼，占28．8％；（2）新生血管性高度近视黄斑病变．22例32眼。占25．6％；（3）漆样裂纹性黄斑出血：12例16眼，占12．8％；（4）高度近视性Fuchs斑：9例12眼，占9．6％；（5）高度近视性黄斑萎缩：14例23眼，占18．4％；（6）高度近视性黄斑裂孔：6例6眼，占4、8％．结论根据高度近视黄斑病变的FFA进行分类有助于明确病变性质、判断预后及指导治疗。【眼科新进展2007；27（2）：113-115】     

Visual outcomes for high myopic patients with or without myopic maculopathy: a 10 year follow up study

AIM: To evaluate the visual outcomes for high myopic patients aged 40 years and older with or without myopic maculopathy. METHODS: 552 high myopic (spherical equivalent < or =-6.0D or axial length > or =26.5 mm) patients were enrolled in the study, 230 cases with myopic maculopathy (at least lacquer cracks were identified) and 322 cases without maculopathy. The initial and final visual acuity (VA) (after 10 years) was compared between two groups. Additionally, the relation between sex, age, refraction, and axial length was analysed to find out the possible risk factors associated with visual outcome in myopic maculopathy. RESULTS: In 92% of patients aged 40-49, final VA was better than 20/40 after 10 years of follow up. However, it was less than 40% in those older than 60 years. For more than 50% of patients older than 40 years of age with maculopathy, their vision had decreased more than two lines in Snellen VA after 10 years of follow up, compared to only 4.3% of analogues without myopic maculopathy. Patchy atrophy and choroidal neovascularisation in myopic macular degeneration groups showed poorer visual outcome than lacquer cracks in the macular lesion group. Other prognostic factors of visual outcomes were myopic refraction, axial length, and ageing. CONCLUSIONS: Clearly, prognosis for patients with maculopathy is poorer than for those without maculopathy. Refractive status, axial length, and ageing are the main factors involved in determining the visual outcomes. The macular grading also affects the visual outcome for high myopic patients.     

严重增殖性糖尿病视网膜病变玻璃体切除术后视功能评价

目的：：探讨玻璃体切除术治疗严重增殖性糖尿病视网膜病变( proliferative diabetic retinopathy,PDR)Ⅵ期患者术后视功能的改善情况及影响视功能预后的因素,并用多焦视网膜电图( multifocal electroretinography,mfERG)评价视功能的改变。方法：回顾性分析PDR Ⅵ期患者113例130眼经标准的玻璃体视网膜手术治疗后的临床资料,并根据术前OCT检查及术中所见,分为牵拉性视网膜脱离合并显著黄斑病变组(99例113眼)及未合并黄斑病变组(14例17眼)两组。行OCT及mfERG检查,对手术前后视力、mfERG P1波振幅密度、OCT形态学改变、手术并发症及预后等进行重点分析。结果：术后视力改善率63.1%(82/130),视力在0.05以上者从术前19眼(14.6%)提高到术后61眼(46.9%),其中56眼视力>0.1。牵拉性视网膜脱离未合并黄斑病变组术后视力改善率(88.2%)及术后视力>0.1所占比例(94.1%)均高于合并显著黄斑病变组(59.3%和35.4%),差异有统计学意义( P<0.05)。术后mfERG各环P1波反应密度较术前增加,并随着时间延长,改善更加明显(P<0.05),牵拉性视网膜脱离未合并黄斑病变组术后mfERG(1+2)环P1波反应密度高于合并显著黄斑病变组(P<0.05)。结论：PDRⅥ期患者玻璃体切除术后视功能改善;mfERG一阶反应的后极部各环P1波反应密度增加,且随时间延长,改善更加明显;未合并黄斑病变组术后视功能改善优于合并显著黄斑病变组。     

Do patients with age related maculopathy and cataract benefit from cataract surgery?

AIMS—To assess the benefits of cataract extraction in patients with age related maculopathy (ARM).
METHODS—1073 randomly selected cataract operations were reviewed and 99 cases of preoperatively recognised ARM were identified for investigation. Data relating to visual function were retrieved from case notes, and patient responses to a questionnaire were analysed.
RESULTS—98% had dry or unspecified ARM. Only 2% had exudative maculopathy. 81% of cases had an improvement in best distance acuity; mean change 0.44 logMAR (change of 6/36 to 6/12). 65% responded to the questionnaire; 67% felt that the operation had been worthwhile, 17% had mixed feelings, and 17% thought it not worthwhile.
CONCLUSION—This study, which is the first of its kind to be reported, shows a clear benefit from cataract surgery in the majority of patients with ARM. However, the prevalence of ARM in this study is lower than expected, suggesting that some patients with both ARM and cataract were not listed for surgery. The design of a prospective study to quantify the subjective and objective benefits of cataract surgery in these patients is outlined and predictors of successful outcome identified. This will promote the development of guidelines for the surgical management of this group of patients.

Keywords: age related maculopathy; cataract; cataract surgery; outcome assessment; questionnaire     

Diabetic retinopathy progression and visual outcome after phacoemulsification in South-Asian and Afro-Caribbean patients with diabetes

PURPOSE: To determine diabetic retinopathy or maculopathy progression and visual outcome following phacoemulsification in South-Asian and Afro-Caribbean patients with diabetes. METHODS: Review of notes of patients with type II diabetes undergoing phacoemulsification by one surgeon. The inclusion criteria were: (a) South-Asian or Afro-Caribbean ethnicity, (b) monocular cases with a minimum postoperative follow-up of 6 months, and (c) binocular cases with an interval of at least 6 months between the operation in the two eyes. The nonoperated eye was used as control. The development or progression of diabetic retinopathy or maculopathy and final visual acuity were recorded. RESULTS: In all, 30 diabetic patients were included. There were 19 South-Asians (Pakistani, Indian, and Bangladeshi) and 11 Afro-Caribbeans. The mean (+/-SD) age was 68.9 (+/-10) years. Retinopathy or maculopathy progression was noted in seven patients (23.4%), two South-Asians, and five Afro-Caribbeans. There was no significant difference in the number of operated and fellow eyes whose retinopathy or maculopathy progressed postoperatively. Progression of retinopathy or maculopathy occurred more often in Afro-Caribbeans compared to South-Asians (P=0.02, logistic regression analysis). The mean (+/-SD) postoperative follow-up was 12.4 (+/-6.5) months. Visual acuity improved by at least two or more Snellen lines in 19 eyes (63.3%); 26 eyes (86.7%) achieved a final visual acuity of at least 6/12. CONCLUSIONS: Afro-Caribbeans may be at a higher risk of progression of retinopathy or maculopathy after phacoemulsification.     

Optic disc edema with aphakic cystoid maculopathy masquerading as ischemic optic neuropathy

Two patients with visual loss after cataract extraction were found to have prominent pallid optic disc edema, peripapillary hemorrhage, and cystoid maculopathy. A diagnosis of anterior ischemic optic neuropathy, with coincidental aphakic cystoid macular edema, was initially considered. The clinical course, however, favored a diagnosis of visual loss secondary to maculopathy. In both cases, fluorescein angiography disclosed leakage of fluorescein dye from macula, optic disc, and peripapillary foci. Fluorescein angiography and stereo color photographs of 51 patients with aphakic cystoid maculopathy were reviewed to determine the incidence of optic disc edema. Although optic disc swelling was rarely recognized on fundus photography, optic disc hyperfluorescence was observed in 75% of cases.     

严重增殖性糖尿病视网膜病变患者术后疗效及影响因素

目的：分析严重增殖性糖尿病视网膜病变(PDR)玻璃体手术后的疗效及影响因素。

方法：将2015-01/2018-01我院收治的PDR Ⅵ期患者(94例112眼)按OCT情况分为黄斑病变组(61例70眼)与无黄斑病变组(33例42眼),比较两组随访6mo视力、黄斑区P1波振幅密度和视网膜复位情况,以视力改善作为疗效评估标准,分析PDR Ⅵ期术后疗效和影响因素。

结果：无黄斑病变组术后6mo视力分级优于黄斑病变组(P<0.05)。术后6mo黄斑病变组(1+2)环P1波振幅密度低于无黄斑病变组(P<0.05)。所有患者中,患眼1次手术视网膜解剖复位95眼(84.8%),2次复位10眼(8.9%),3次复位2眼(1.8%),4次复位1眼(0.9%),未复位4眼(3.6%),总复位率96.4%。合并黄斑病变、长糖尿病病程患者视力改善有效率低于未合并黄斑病变、短糖尿病病程者(P<0.05),合并黄斑病变、糖尿病病程均为影响严重PDR患者术后疗效的独立因素(P<0.05)。

结论：玻璃体切割术可改善PDR Ⅵ期患者术后视力,术前合并显著黄斑病变和糖尿病病程是影响严重PDR患者术后疗效的重要因素。     

Radio-induced maculopathy

Macula was examined using fundus photo and OCT in 115 patients with choroidal melanoma located distant from macula before and after brachytherapy. Macular changes were revealed in 24,35% of irradiated eyes. Nevertheless primary radiation-induced maculopathy after ruthenium plaque radiotherapy occurred in 9,59% only. In the rest of cases (10,43%) macular changes were present before brachytherapy. The causes of their development were choroidal melanoma (tumor-associated maculopathy) and AMD.     

温州医科大学附属眼视光医院玻璃体切割术 适应证及术式10年变化趋势

目的：探讨温州医科大学附属眼视光医院2010年至2019年间玻璃体切割术适应证及术式的变化趋势。 方法：回顾性系列病例研究。纳入2010年1月1日至2019年12月31日在温州医科大学附属眼视光医院行玻璃体切割手术的病例22 491例,其中男12 287例,女10 204例,年龄1～95岁。根据玻璃 体切割手术适应证（视网膜脱离、糖尿病视网膜病变、黄斑病变、眼外伤、无视网膜脱离的玻璃体视网膜疾病、晶状体病变及其他眼病）、手术类型（前段玻璃体切割术、单纯玻璃体切割术及玻璃体切割联合晶状体手术）及玻璃体腔填充物（气体、硅油及其他液体）进行分类,对上述适应证、手术方式变化趋势及患者的人口学资料进行统计学描述。 结果：温州医科大学附属眼视光医院玻璃体切割术年手术量由2010年的1 398例逐渐增加至2019年的3 791例。患者年龄由2010年的（50.1±16.4）岁 上升至2019年的（57.2±14.5）岁,以男性为多,但女性比例逐年增加（由2010年的39.7%增至2019年 的46.6%）。2010年至2019年间,前4位玻璃体切割术适应证依次为视网膜脱离（29.4%）,黄斑疾病 （22.0%）,糖尿病视网膜病变（19.7%）及眼外伤（15.5%）。因黄斑疾病接受手术的患者数量及构成比逐年增多,由2010年的195例（14.0%）增加至2019年的1 054例（27.8%）,已成为玻璃体切割术的首位适应证。手术类型方面,玻璃体切割联合晶状体手术为13 896例（61.8%）,所占的比例明显上升（2010年55.2%,2019年69.0%）。玻璃体腔填充物方面,气体及硅油是玻璃体切割术后的主要填充物（2010年占83.4%,2019年占74.9%）。近5年硅油填充比例较前5年下降（2010─2014年期间占 40.2%～43.8%,2015─2019年期间占34.1%～39.6%）。 结论：2010─2019年温州医科大学附属眼视光医院玻璃体切割手术的主要适应证为视网膜脱离、黄斑疾病、糖尿病视网膜病变。其中黄斑疾病占比逐年增加。玻璃体切割联合晶状体手术已成为主流术式。10年来玻璃体切割术后硅油填充的使用比例在逐渐下降。     

Ophthalmic survey of a diabetic clinic: II. Requirements for treatment of retinopathy.

The eyes of 658 patients attending a district general hospital diabetic clinic were examined for retinopathy requiring treatment by photocoagulation or vitreoretinal surgery. Although the majority of patients with serious retinopathy were already under ophthalmic supervision, 39 cases (52 eyes) were found which required treatment. Eighty eyes had had previous photocoagulation, and treatment was recommended for maculopathy in 40 eyes, proliferative retinopathy in seven eyes, and combined maculopathy and proliferative retinopathy in five eyes. This suggested that existing referral criteria for photocoagulation in the population studied were reasonably accurate for proliferative retinopathy, but maculopathy was more frequently overlooked. In insulin dependent patients (IDDs) undetected maculopathy was found in 17/416 eyes, (4.0%) and in non-insulin dependent patients (NIDDs) 28/899 (3.1%). Untreated proliferative retinopathy was discovered in 5/416 (1.2%) IDD eyes and 7/899 (0.8%) of NIDD eyes. Vitreoretinal surgery was required in six eyes (0.5%) for vitreous haemorrhage or traction retinal detachment. Equipment for the treatment of diabetic retinopathy is now almost universally available in ophthalmic departments, but time for patient management by trained staff may be inadequate. Each UK ophthalmic consultant needs approximately 100 sessions per year to monitor and treat known cases of retinopathy apart from time required to train junior staff.     

糖尿病视网膜病变与黄斑病变的关系探讨

目的 探讨糖尿病视网膜病变 (diabetic retinopathy, DR) 与糖尿病黄斑病变(diabetic maculopathy, DM)之间的关系,以探讨DM独立分期对指导临床治疗的意义。 方法 对眼科初诊的582例糖尿病患者行荧光素眼底血管造影 (fundus fluorescein angiography, FFA)及眼科常规检查,根据眼底改变将DR分为2型6期,DM分为4度。 结果 DM的严重程度随DR的逐渐加重而增加,但不完全平行。在无DR病例中,发生I度DM者占 5.4%;IV期DR中,III度DM发生率最高,占54.4%;Ⅴ期DR中,仍有未发生DM的病例,占5.1%。 结论 DR和DM之间不完全平行,故DM独立分期对选择黄斑区最佳治疗时机,保存黄斑功能有重要意义。 (中华眼底病杂志,2000,16:153-154)     

Optical coherence tomography findings and retinal changes after vitrectomy for optic disc pit maculopathy

Purpose:

To study the optical coherence tomography (OCT) patterns in optic disc pit maculopathy and retinal changes after vitreous surgery.

Materials and Methods:

Retrospective review of consecutive cases with optic disc pit maculopathy seen at two tertiary eye institutes from January 2005 to June 2009.

Results:

Twenty-four eyes of 23 patients are included. The presenting visual acuity ranged from 20/400 to 20/20 (median:20/80). The median age at presentation was 24 years (range, 6-57 years). Optical coherence tomography demonstrated a combination of retinoschisis and outer layer detachment (OLD) in 19 (79.17%) eyes, OLD only in 3 (12.5%) eyes and retinoschisis only in 2 (8.33%) eyes. An obvious communication (outer layer hole) between the schisis and OLD was seen in 14 (73.68%) of the 19 eyes with both features. Of the 21 eyes with retinoschisis, schisis was present in multiple layers in 15 (71.43%) and single layer in 6 (28.57%) eyes. Eleven eyes underwent pars plana vitrectomy including creation of posterior vitreous detachment (PVD), fluid-air exchange, low intensity laser photocoagulation at the temporal edge of the optic disc pit and non-expansile perfluoropropane gas (14%) injection. Five (45.45%) of 11 eyes undergoing vitrectomy had complete resolution and 4 (36.36%) eyes had partial resolution of maculopathy. Visual acuity improved in 8 (72.72%) of 11 eyes.

Conclusion:

Optical coherence tomography demonstrates multiple layer schisis and outer layer detachment as main features of optic disc pit maculopathy. Vitrectomy with PVD induction, laser photocoagulation and gas tamponade results in anatomical and visual improvement in most cases with optic disc pit maculopathy.     

Long-term results of vitrectomy for removal of submacular hard exudates in patients with diabetic maculopathy

PURPOSE: To investigate long-term results of vitrectomy for the removal of submacular hard exudates in patients with diabetic maculopathy. METHODS: Thirteen eyes of 10 patients with diabetic maculopathy underwent vitrectomy to remove submacular hard exudates from December 1993 to March 1999. The mean preoperative logMAR visual acuity +/- SD was 1.54 +/- 0.43. Preoperatively, the exudates ranged from 0.5 to 3 disk diameters (average, 1.25 disk diameters). Exudates were removed using subretinal forceps through a minimal paramacular retinotomy after vitrectomy. In all cases, 20% SF6 gas tamponade was added. The mean postoperative observation period was 43.2 months. RESULTS: Visual acuity was improved in 7 eyes (54%) 1 year after surgery; however, visual acuity over longer periods was improved in only 5 eyes (38%) as compared with the preoperative findings. The mean final visual acuity +/- SD was 1.62 +/- 0.59, which did not show statistically significant improvement over that in the control group. Although submacular hard exudates and macular edema disappeared during the postoperative period, atrophic or degenerative changes occurred in many cases. CONCLUSION: Visual improvement could not be obtained for a long period after removing submacular hard exudates in most of the patients, suggesting that diabetic maculopathy should be treated before massive exudate deposits appear in the macula.     

Cystic maculopathy with normal capillary permeability secondary to docetaxel.

BACKGROUND: Cystic maculopathy without leakage on fluorescein angiography has been described in cases of toxicity to niacin. We present a similar case of cystic maculopathy due to docetaxel (Taxotere) in the treatment of breast cancer. CASE REPORT: A 53-year-old Asian female presented with complaints of decreased vision soon after the initiation of treatment for breast cancer with docetaxel. A cystic maculopathy with a normal fluorescein angiogram was found on examination. Significant improvement in visual acuity along with resolution of the cystic maculopathy was found after changing to an alternate antineoplastic agent. CONCLUSION: Docetaxel may be associated with cystic maculopathy that does not display angiographic evidence of abnormal capillary permeability.     

糖尿病性视网膜病变眼底荧光血管造影分析

目的探讨糖尿病性视网膜病变(DR)的毛细血管无灌注区(NP)的分布特点及黄斑病变的发病特点。方法回顾分析DR患者126例(239只眼)应用眼底荧光血管造影(FFA)的检查资料,分析NP的分布特点及黄斑病变特点。结果在126例中,有75例(102只眼)存在NP,NP发生于视网膜鼻侧、下方、上方及颞侧的发生率分别为81.37%、71.57%、60.78%及53.92%,发生于中周部、周边部、后极部分别为84.31%、42.15%及14. 70%。黄班病变出现56例(96只眼),占41.17%,其中局限性黄斑水肿占21.87%,弥漫性黄斑水肿占48.96%,囊样水肿占22.92%,缺血性黄斑病变占66.25%。结论视网膜中周部及鼻侧象限是NP最常发的部位,黄斑病变随着DR程度加重而加深,但没有严格对应关系。     

Three cases of hypotonic maculopathy due to blunt trauma,treated by 360-degree scleral buckling

BACKGROUND: In hypotonic maculopathy with a shallow anterior chamber, it is difficult to delineate the extent of cyclodialysis. Reoperations are often reported, and a method of management for hypotonic maculopathy is not yet established. CASES: We treated three patients with hypotonic maculopathy due to blunt trauma. Case 1 did not improve after two cryoablations, two cyclopexies, and a laser photocoagulation treatment. Cases 2 and 3 did not improve after a single laser photocoagulation treatment. All cases exhibited retinal breaks, and underwent 360-degree scleral buckling. RESULTS: In all cases, intraocular pressure was normalized soon after the surgery. We found that ultrasound biomicroscopy (UBM) was helpful in clarifying cyclodialysis, and that optical coherence tomography(OCT) was useful to observe morphologic changes of the macula in detail. CONCLUSION: This procedure is considered to be useful in the treatment of hypotonic maculopathy.     

Hypotony maculopathy

Hypotony maculopathy, first described in 1954 by Dellaporta, usually occurs after antiglaucomatous surgery or after perforating eye injuries; it is characterized by hypotony associated with fundus abnormalities, including papilloedema, vascular tortuosity and chorioretinal folds. In hypotony maculopathy, the scleral wall collapses inward, resulting in redundancy of the choroid and retina, leading to chorioretinal wrinkling. As the antero-posterior diameter of the vitreous cavity decreases, the very thick perivofeal retina surrounding the very thin foveal retina is thrown into radial folds around the fovea. It has been reported that hypotony maculopathy occurs in up to 20% of cases of glaucoma filtering surgery and has become more common after the introduction of antimetabolites. Young age, myopia, primary filtering surgery, systemic illnesses and elevated preoperative intraocular pressure (IOP) have been found to be associated with hypotony maculopathy. Hypotony maculopathy is treated with procedures designed to elevate IOP, which may reverse the inward scleral bowing and improve visual acuity. The successful treatment of hypotony maculopathy depends on the correct identification of its cause. Once the cause is detected, treatment should be employed as soon as possible because delayed normalization of the IOP may result in permanent macular chorioretinal changes and poor vision. This review will explore the definition, mechanisms, clinical findings and treatment of hypotony maculopathy.     

Photocoagulation with continuous wave ND:YAG laser for neovascular maculopathy.

Twenty-two eyes in 22 cases of neovascular maculopathy were treated with continuous wave (CW) Nd:YAG laser and followed up for 6 to 24 months. The effect of the treatment was evaluated by repeated visual acuity testing, fundus photography, fluorescein angiography and automated static perimetry. In 91% of the patients visual acuity remained unchanged or improved. Fluorescein angiography revealed that the neovascularization disappeared in 91% of the patients. In 40% of the patients the central visual field showed improvement by automated static perimetry. These results indicate that CW Nd:YAG laser photocoagulation is useful for the treatment of neovascular maculopathy.     

Presentación multifocal en 2 casos de maculopatía unilateral aguda idiopática

Two cases of multifocal unilateral acute idiopathic maculopathy are presented, one in a 24 year-old man, and another in a 37 year-old woman. Both of them presented with acute vision loss and clinical findings compatible with unilateral acute idiopathic maculopathy. As a relatively uncommon finding, they had multifocal lesions around a larger central lesion. They experienced a spontaneous improvement of their vision.Atypical presentations of unilateral acute idiopathic maculopathy like multifocal lesions are possible. Ophthalmologists should be aware of this rare form of presentation.